Final Report

It seems unlikely that I will achieve much more work this weekend - I've gt a lot of beer drinking and socialising planned... so:

1. Dentist visited; my teeth hurt more now, and I've gotta go again next month. I believe I'm putting his kids through College

2. Optician visited; eyes are fine

3. Hair cut; ears drafty

4. Hot water repair arranged; next week, I hope

5. Fence repair arranged; 10 days

6. House semi-tidy; about as good as it gets...

7. House re-mortgaged

8. Suits drycleaned.

9. Thought about painting; fail...

10. Paperwork up to date

11. And filed!

12. Audits still unwritten; fail...

13. Presentations done and done

14. Case report still in the pipeline; fail...

So, I got most shit done, and what isn't done should be within the week... not bad by my standards. Photos of fence to follow...

Oh, and I had my car serviced....

I realise this is all in a day's work for most people, but it's quite an achievement for me....

Heartwarming

The news today is full of a story concerning an off licence use of Viagra (sildenafil) to further the recovery of a premie baby.

This use is not really news. I'm sure you all know what Viagra is used for now, but it was intended as a drug to lower blood pressure. And it has found use in treating pulmonary hypertension in newborns before.

This provoked much controversy.

I must confess to being unaware of this potential use for Viagra before today, but received the news with great joy. Not just because a baby is alive who might otherwise be dead. But also because it does a little to restore my faith in medicine. There is a grand tradition of using unorthodox treatment in medicine. I remember my first boss reacting angrily when told by a drug rep that he couldn't use a particular medication in the way he did, because it was off licence. He was quite confident in his medical knowledge, backed by many years of experience. He reminded me that Registered medical practitioners are entitled to prescribe as they see fit. I suspect the local formulary has more to say about it these days...

In the 'good old days', I'm sure many unorthodox / experimental treatment was carried out without full consent. While I don't condone this, I can't help bu feel that the pendulum has swung too far the other way. In the modern age of Evidence Based Medicine and protocol driven care, delivered by practitioners with limited knowledge base and experience , there seems to be little room for the use of a medication or treatment for any purpose than the manufacturers intend.

I'm not proposing that patients should be peppered with untested drugs, or at random. But I think we are loosing the part of medicine that was, and is, it's art. The science is stronger than ever, but there should be more to it than that.

Sometimes you have to think laterally.

A Professor of Surgery, under whom I worked when I was an Anatomy Demonstrator wrote this:

And how many of us, having carried out some new and untried treatment, have had this experience of being unable to sleep and of creeping to the ward before anyone else is around, with pulse racing, to see whether the treatment has been a brilliant success or a disastrous failure!*

That was published in 1996. I suspect the answer is 'none of us', now.

So give thanks today, not only for a life saved, but for a flicker of life in the Art of Medicine.

-------------------------------------

Operations that Made History, Ellis H CBE; Greenwich Medical Media 1996

Things That Are Really Pissing Me Off

The insistence of several publications in referring to "MSSA, a strain of MRSA".

MSSA, a term I have never heard used by medical professionals, is Methicillin Sensitive Staph Aureus. Or just Staph Aureus, really. Surely MRSA (Methicillin Resistant Staph Aureus) is the strain here...

It also occurs to me that the existence of MRSA where once there was only SA goes a long way to supporting the theory of evolution. Any Creationists out there, I welcome comments, etc

Take A Little While To Grow Your Brother's Hair

Pure nostalgia tonight.

My experience of blogging strikes me as odd. While the process of writing is cathartic (although you could argue I could achieve the same thing by actuall talking to people), I have found myself inevitably drawn into the Blogging community.

I start to wonder who is reading this nonsense, and of course, I've started reading other peoples blogs. There are millions out there, so I'm sure I'm missing millions of great blogs; but those that I do read attract my attention, smetimes because they comment on my blog, sometimes because someone else recommends them.

Anyway, those that I try to read regularly I find well written to a fault, and all have something worth saying. Many of them express sentiments that I share much more eloquently than I could ever hope to. Variety is the spice of life, I guess. Like good books, these blogs can start to feel a bit like old friends.
Or new friends;
or whatever.

The point I'm rambling toward is that sometimes these folks go missing. Everyone has they're own reasons for not posting. None among us are doing this professionally, as far as I can gather, so life gets in the way. But... you can't help but wonder. Part altruism (are they o.k?) part selfish (I was reading that!)

Well, a couple of the blogs I follow had been silent for a while, and are now going again. Which is nice. I'm glad you're both posting again. Welcome back, for what it's worth.

I was watching an episode of TV Medical soap Holby City tonight. (If you're not aware of it, think Chicago Hope; if that doesn't help, then Nuts to you.) The entire episode was set during the late / night shift. It made me quite nostalgic for nights on call, if you can believe it. Then a number of glaring technical errors became apparant to me, and rage became my dominant emotion. I've self medicated with alcohol, though, so it's ok.

It does bring me to my own peculiar rose tinted specs. Hard and sometimes frightening as my nights on call were, I now look back on them with fondness, both as times when I was happy, and as a macho badge of homour. (I've been prone to use "In my day..." - type aphorisms since I finished my Pre-Reg year. (And, yes, I know, I'm an arse. But thanks, anyway.)) It makes me wonder, though... was it really any beter? The prevailing wind in medical politics at the mo' is that things are worse now than they were a few years ago.

This isn't quite the same thing. There is no doubt in my mind that that Bitch Hewitt has fucked the NHS royally. But it has pretty much been the aim of every Govt since 1948 to break the power of the medical profession. As to the idea that Doctors earn too much, I say Bollocks. Yes, we earn good money, but compare the amount a surgeon gets* for removing your cancerous intestine, and potentially saving your life with the fee a Solicitor gets for conveyancing your house.

They started it.

Nye Bevin promised to choke our throats with gold, and no-one stopped to think that good Health Care would become increasingly burdened, no less so.

I did have a point to make. I'll try to come back to it when I can think straight.

------------------------------------------------------------

*(about 600 quid in Pa Shroom's day ( I know the bill will be more than that, but 600 is the suregeon's fee, and it includes all the post op care while your in hospital, which might be two weeks.)

She Has Robes And She Has Monkeys

She lives on Love Street...

So I've reached halfway point of my leave.
Rather lamely, I don't feel I've achieved anything. I worked last Sunday night, so last Monday was a right-off, and then I worked Wednesday night too, so that ballsed up Weds / Thurs, and I've been fairly vegetative since. However, I am on track to have got things done, which is an unusual change for me. Details to follow at the end of the week. If Colossus is still out there, I know he's expecting much inertia. We'll see.

As an extra task, I'm going to try and hook up with a few old friends. Guys I went to school with, but don't see very often - both distance and the NHS get in the way. The problem I usually have is that they've invariably organised something to do- which is not unreasonable. I believe it's called having a life. I can almost remember when I had one myself... (cue violins, droning in the background)

But it's frustrating to find out all your friends are up to something you can't get involved with - usually because it's a ticketed affair, or whanot. A painful reminder of how far out of my old social circle I've fallen. Time marches on for all of us, I guess. I can't remember if I've mentioned this before, but Pa Shroom once told me he was meeting a friend of his, whose Best Man he'd been, but had hardly seen since. Naively, I used to wonder how such a thing could happen.

It's all too clear to me now.

Well, you pays your money, you takes your choice.

If any of my dear readers share my affection for Bruce Springsteen and the E Street Band, I urge you to invest in a copy of his live performance from 1975 at Hammersmith. But I imagine most of you won't be interested. Shame on you.

Thought For The Day

"Sometimes you have to sink all the way to the bottom, before you can begin to climb back up..."

Hardly Dr Kildare

I've taken a break from pilfering song lyrics to raid TV instead. The mighty Richard Chamberlain as arguably the first and most famous of TV Docs. (Albeit one fading fast from public consciousness now, I suspect)

The reason he's on my mind is another abortive attempt of mine to play the medical hero. Deep in the back of my psyche lies a part of me that longs to run around in orange jumpsuits, shouting "stat" quite a lot. To slake this beast, I'm prone to stopping at accidents, if it seems I'd be able to help. In my mind, I will undoubtedly perform an heroic intervention, smooth my hair back into place, and stroll off into the sunset, adoring crowds swooning behind me. In practice, there's actually very little to be done in most cases. Which is generally good. If there is something I should be doing other than providing reassurance, the patient / victim is unwell, and probably needs proper equipment.

Frankly I should just stop.

Besides which the Paramedics never believe you, unless you're a recognised Out-Of-Hospital provider and driving a flash car with "Doctor" written on the side; and even then I suspect they feel you're just getting in the way.

Today, I was driving to the opticians, when I came across a young woman recumbent under a car. In actual fact she didn't seem to have sustained any serious injuries, and was conscious and talking throughout; the doubt seemed to be about how to get her out... I suspect she could have been slid out on a backboard, but didn't stick around once the Paramedics showed up. I guess I know just enough not to make things worse. I think all I really achieved was lending authority to the request for the massive crowd of rubber-neckers to bugger off.

I guess I should just leave the heroics to the experts, eh. And the TV Docs...

What We Did On Our Holidays

Actually, what I need to do. I'm on leave, except for the odd night here and there. I've got a post or two brewing, but I thought I'd leave an electronic record of stuff I need to get done over two weeks, so we can all see how rubbish I am...

In no particular order....

1. Visit Dentist

2. Visit optician

3. Get hair cut (6 months goes by so quickly...)

4. Get hot water fixed in my house (it's been two years, I think...)

5. Fix my fence

6. Tidy my house

7. Sort a new mortgage

8. Get my suits dry cleaned

9. Paint my house (!)

10. Finish an interminable amount of paperwork

11. File said paperwork

12. Write up 2 audits

13. Prepare 2 presentations

14. Re-submit a case report

15. NOT spend all day surfing the net.

Wish me luck. Update to follow in 10 days. Some photographic evidence may be submitted...

Fishlady, Oh Fishlady....

I've struggled to post the past few days. I'm not sure why. The computer at work was being frustratingly slow, and I guess I get discouraged easily. Another of my enviable character traits. Not much has happened either, which doesn't help...

So just a few random thoughts, I guess.

I think I've had another hard week; I'm not sure why. I'm due a break - in fact, I'm on one now - so maybe I'm just tired. Snappier than usual, which didn't endear me to my colleagues, I'm ashamed to say. What's done is done, unfortunately. We've seen a lot of overdoses this last week. Maybe more than usual; maybe not.

Feels like more than usual tho'.

In general, we do see a lot of this presentation. My experience of the psychiatric services in the U.K. has not been good. This is not an implicit criticism of the people that do the work; I don't know nearly enough to start down that line. It's merely an observation, and I assume the problem is an overstretched, understaffed service.
Part of the side effect I feel from seeing so many of these cases is that I start to become unsympathetic. This not a good thing; but I have to admit, I find it hard, when I see so many people who lie about what they've done, or what they've taken. People who seem to be in it to abuse the system, or, God forbid, for the attention.

Let me repeat - this is not right. I am not trying to justify myself. You just need to know. Well, as much as you need to know any of the drivel I'm prone to vomiting forth.

Well, I saw a couple over the last few days who really got to me. Regular people, not serial offenders. People whose lives had taken a series of turns leading them down an alley so dark they couldn't see the way back. Couldn't even see that there IS a way back. Neither of them had taken ODs likely to cause physical harm, so I referred them on the way. I'm not sure I was any help at all really, tho'.

On a lighter note, I was getting my hair cut today, and the place was awful cold. I became acutely aware of the temperature differential caused by the hairdresser. It's amazing quite how much heat a body radiates. Or not. Maybe you had to be there.

The Stench Of Gin and Remorse

A few images:

Both MR views of the patient with a T6 fracture from previous posting

Before...

After...

A nice reduction of a trimalleolar fracture, done by one of our students. We were generally impressed.

Not much happened of note today. Lots of docs, not so many patients. I did, however, receive a rejection letter from the Annals. Which basically sucks. Ah, well. Try, try and try again.

One of my good friends and colleagues has discovered that I pollute the blogosphere with, well, this. He's now quite keen to read it; I'm not sure I want him too, which is essentially lame, but there you go. Anyway, he's set on trying to find me, but I suspect he'll:

• forget
• lose interest.

If you have found your way here Colossus, welcome aboard. I'm fairly sure I haven't ben rude about you, so - enjoy!

----------------------------------------------

Started reading something or other about Jack The Ripper. Nice.

The Rag Man Draws Circles...

Another tough day.


I feel shit today. But that's my problem. More of that later.


Yesterday...

I had a tough day, but it was bookended by two people having it far worse...

It began:
A young fella, fallen from a window. I'm not sure how. In the final analysis, does it really matter? We always ask 'how?' People rarely remeber. Why should they? It's the last thing on their minds. How he landed was more important, but we don't know that either. He was admitted overnight, so one of the other middle-grades worked him up. The unalterable truth, the only detail that mattered was the sensory level at T8. Below that, he could not feel a thing. Not a flicker of movement, no reflexes.


Nothing.


By the time I came on, at eight, he was still waiting for a CT scan. All the important folks had been contacted, and all offered the same grave opinion. I was to go down with him. Hold his hand. Sympathise. Console? Give him morphine, really, and try and keep him calm.


The Department was empty at eight. By nine, we were drowning, flooded by a tsunami of octogenarians. (This phrase was coined by one of the SHOs. Thanks, Baron)


We stayed in the Department, he went down without me.




The scans didn't bring better news.

Peg Fracture

Burst Fracture T6

Significant intrusion into the Spinal Canal

The MRI wasn't any more encouraging.

So the most significant part of my day was telling a family their son would never walk again.

-------------------------------------

The day ended with my relief not showing up. I was already tired, but someone needs to stay on. As one last offering, the Ambulance service spewed forth another wretched supplicant. A young man. Found collapsed. How? We always ask... no-one knows, but we always ask. How long? We always ask...

I had hoped to get the SHOs to run this case, but it was too complex. He was too unwell. My brain chose this moment to slip into neutral. Running on autopilot. Back up arrived promptly from the ITU. Every question we ask gets a worse reply.

---How long was he down for? We don't know

---How's he been since you found him? He arrested just after we got there; came back after four minutes, but he hasn't woken up

His blood pressure wouldn't hold up, his ABGs were rotten. At least his sugars and his temperature were normal. He rides down to the scanner, accompanied, but unaware. The scan comes back normal. This is as close to a good thing as you can get in a situation like this.

The second significant thing I did was tell another family their father was in a deep coma, and I didn't know why, or for how long.

We did manage to relocate someone's ankle in the meantime. I'll post the films after the weekend, as it's an excellent job, and the guys that did it deserve credit.

Why do I feel shit? I don't know, but I slept badly, and woke up with swollen eyes and a sore throat. Coming down with something? Probably. Would help me explain why I slipped into neutral last night. I hope the patients didn't notice.

Monkeys for Everyone (Mainland Europe only. Some restrictions apply)

I spotted this in the London Times yeaterday. The Government has set up a web page, enabling any Tom, Dick or Harry with internet access to send them an 'e-petition'. This has great scope for mischoief, and the British public has not disappointed.
A petition to equip disabled people with helper monkeys, seems well within the grand tradition of tomfoolery, or gentle mocking of authority. What the Times, and indeed I, find more interesting is the Government's response.

For those among you who can't be arsed, the most salient point seems to me to be:

While we are aware of similar initiatives already in existence, the Government does not currently have any plans to make monkeys available to people with disabilities

Aware of similar initiatives..? Anyone know? Are the French giving out helper monkeys? The Spanish?

Good Times, Bad Times

Something of a mixed bag.

Somedays, I feel like I'm flying at work - not literally, you understand - but in that everything I do works, goes smoothly and results in fantastic relief for all my patients. No matter how complex the problem, or how many patients the God of ED lobs your way, I manage them all, slickly, with aplomb, leaving everyone wanting more. (Who was that masked man... **swoon**)

Somedays it feels like I'm swimming through treacle, carrying breeze blocks chained to my balls.

I must admit, I think I thrive on stress. When the Department is busy, it gives me the chance to pretend like I'm in ER, dashing about, shouting 'important' orders, saving lives. It's an ego boost when the nurses refer the complex cases, or sick patients to me.

The Arrogant Shroom knows it's because I'm just that damn good.
Realist Shroom knows it's because I'm the only senior on the floor.

Busy days give Shroom the opportunity to fly, wowing everyone. (In his own mind, in case this isn't clear - Ed.) On a bad day I'm prone to decompensate. Today was one of those days. The Department filled up pretty quick with patient after patient needing close attention, and after I had three on the go, and the Charge Nurse pulled me to one side to tell me there was someone sick as a dog in Resus, I was ready to tear my hair out. Fortunately several of my bosses were about, so I had some support, but Arrogant Shroom doesn't like to have to admit that he's only human, and can't single handedly cure the entire South Coast.

So, today we had:
--- 96 y.o female, probable stroke, GCS 7
--- 86 y.o female, collapse, hypothermic, low GCS
--- 18 y.o. male, fall, with head, arm and leg injury
--- 81 y.o female, found collapsed at home, possible stroke, possible MI

These guys didn't all arrive at the same time, but they were all here at the same time, and all ended up with the Shroom as their Doc du Jour. It felt a bit like fighting the Hydra, chopping off heads left, right and centre, only for more to spring forth. Fortunately I have the support of many excellent Docs and Nurses, not least to stop me getting an over-valued idea of my own self-importance.

The last two patients in my run of six affected me the most. One was an elderly chap, who had collapse in the barbers, and arrived GCS 3. We worked on him a bit, and he perked up to GCS 7. If he was another stroke, not much was on offer. These cases do badly, and end up with left lateral and TLC (tender, loving care) until it's their time to go. If it's a big bleed... well, you never know. The Boss couldn't find enough clinically to call it a stroke, so we headed for the Doughnut of Doom.

For those not familiar with head CTs, all that white stuff in the middle of the picture is blood; and none of it where it should be. Unsurvivable; unsalvagable; do not pass go, do not collect £200. Time for bed, sir.

We had to call the fella's wife in. Sometimes, when the patient is elderly, their spouse - also elderly - has no idea what's going on. I feared the worst in this case, as the lady had no-one to come with her, no support, no-one to lean on. When I stepped in to see her, she was one step ahead of me - had heard it in our voices, she said. Her strength in the face of the horror I unburdened onto her took my breath away. To lose your soul mate of decades in the blink of an eye... I can't even begin to imagine it. This woman's quiet, dignified grief made me ashamed, and I'm not sure why. But I'm glad we had our diagnosis, and I'm glad we could keep him alive long enough for her to see him one last time. Too many people shuffle off with only people like me for company.

The second case has a brighter outcome, so far. Another elderly chap, this time with severe chest pain. Initial ECG, in the back of the Ambulance was non-diagnostic. Then, as he was rolling up outside, that all changed. His ST segments pulled up in II, III and AvF. Barn door inferior MI

Time for a spot of thrombolysis. For this patient, the agent of choice, in this hospital, is the venerable streptokinase. The patient was understandably shaken when I told him what was a'goin' on. But he got with the programme, and we plumbed him into the magic clot-busting elixir.

I fucking hate streptokinase.

Half an hour later, they called for me. The patient was sitting up on the trolley - pale, clammy and gazing off into the distance. I can't quite put it in words, but I've seen this look before. I'm sure all medics have. 'The lights are on, but no-one's home' is the closest I can get. His gaze began to drift off, and his breathing became stertorous, almost as if he was trying to blow bubbles.

"Sir?"

No reply

"Sir?"

Fuck all.

Shit. This guy is stroking out. Right here. Right now. (Activate drama queen mode)

Convinced h was about to arrest, I asked someone to get the boss. I figured if he went, we'd need to scan him quick - if we got him back. His pulse, BP and sats were actually holding up, but he wasn't doing much to keep things that way. I dumped him flat, and got out the BVM, all the while calling his name, and trying not to shit myself.

(This is high on the list of ways NOT to look professional, and co-incidentally, high on the list of things to avoid doing at work)

Sure enough he became apnoeic, for about a minute - felt like an hour - and then came round. Whilst I was overjoyed to see him awake, and alive, this is tempered by the fact that he now thinks I'm a fucking halfwit, as he feels fine, and can't understand why I've got a mask clamped to his face, screaming hysterically.

At that point, the door bursts open - "I couldn't find the boss, so I got two SHOs!" God love my SHOs, but two junior docs, does not equal a consultant.

Subsequently, our patient's ST segments resolved,and he started feeling better. We have commended him to CCU.

I fucking hate streptokinase.

A light note to end on. What my American colleagues would call the Throckmorton sign, a phenomenon we refer to as Percy Pointing to the Pathology. False in this case, but a nice sign, nonetheless.

Nurse, The Screens!

A morally satisfying weekend educating my fellow medics, as the scramble to get MMC boxes ticked heats up.

I also managed to see Ma and Pa Shroom. I was slightly concerned to hear that Pa Shroom's memory is fading. I'm sure this is, at least in part, because he's retired. When he was working, and I was a student, I was always amazed at his superior knowledge of anatomy - even for those bits he didn't cut regularly. Now Pa Shroom bemoans the loss of this knowledge, and he was telling me his short term memory is failing him too. I hope that's all it is. I couldn't bear to see him dementing...

After my hapless flailing at the fairer sex on Friday, a cheeky note from a fellow Blogonaut brought light to my soul. Thanks again, even if you were humouring me.

As the philosopher Springsteen once wrote, "Don't call for your surgeon, even he says it's too late: it's not your lungs this time, it's your heart that holds your fate."

And to finish, a picture that I 'discovered' this weekend it took my breath away. The essence of human spirit?; or maybe just a young, scared boy running for his life...?

More Light Relief...

Either before, or after my previous post, I'd like you to read my current fave joke:

Q: Where is a gorilla in a Mini Cooper likely to be going?

A: Anywhere he God-Damn wants!

(I said it was my fave, I didn't say it was funny)

Maudlin Rambling

More jibber...

--- More about drugs (and the arrival of a fictitious Editor - Ed.)

I said in a comment a while back that I had taken a few liberties with the timeline of events herein. Allow me to elaborate. While I am writing this now, some of this had been going on awhile. It may appear more immediate than it really is. I'm actually regretting bringing the whole thing up, but it is something that gives cause for concern. (No shit, Shroomy - Ed.)
I know a little about drugs from personal experience - booze and fags (and coffee, I guess) being my poisons of choice, so I feel like I know a little about the addiction that makes them so ruinous. Medicine is renowned for being stressful, and some medics almost wear it as a badge of pride. Mostly the more macho end of the spectrum, but you get the idea.
Nonetheless, what is less braggable about, whatever your frame of reference, are the accompanying high rates of substance abuse and dependence that stress seems to generate. It doesn't help that it's so damn easy to, for example, divert narcotics. (I've borrowed that phrase. I hope that's ok, and I hope you don't feel I'm making light of this. I've already touched on the damage booze inflicted on a good friend of the Shroom)
In this specific case, I think my first draft of the post in which I started this was written badly. But I am concerned about a colleague. I've spoken with X, and there is a lot more going on than I thought. In a very real way, it's none of my business, and I hope people will understand if I don't elaborate further. In another very real way, it is my business. We have to look out for each other, right? If the Shroom was in trouble, he'd want to know folks were looking out for him. I have gained some reassurance that drugs do not lie behind what was worrying me. I hope I'm as right this time, as I was wrong before. I'm sure we've all seen how easy it is for something to spiral out of control, and end up the dominant, destructive force in a life.

Drugs are bad, m'kay?

---A bit more maudlin navel gazing.

I occasionally find myself contemplating my place in the world, and who I'm sharing it with. Which is no-one right now. This is fine by me, most of the time. A fella's gotta be happy in his own company, right? Well, maybe, but just at the mo' I'm lonelier than usual. In my first (draft) post about getting yer ya-ya's out, it was this I was referring to, crudely, when I wrote that I wasn't getting any. (Classy - Ed.). Not the drugs (still classy - Ed.), in case you were thinking I'm more degenerate than you had at first guessed. I'm still fighting off the nicotine, and can do without another addiction, thanks.

So, I'm footloose and fancy-free, but a bit miserable with it. But I could probably get my ya-ya's out, at a push.
Well, today, I set out to rectify the situation. The Shroom has been sweet on one of his colleagues for a while; we don't work together all that much, the shift system being what it is, but we were on together today. Now was my chance! Those who know the Shroom will not be surprised to discover that he deployed his usual charm , and flailed about, failing to broach the subject at all. However, I did find out my mission was a lost cause, after she'd gone home for the day, by discovering she's already seeing someone. I'm fairly certain I managed this clumsily enough that she will already know I was asking about her.
So: to summarise, no date, and I managed to make myself look clumsy and gauche. (Result! - Ed.)

--- Final minutiae of The Shroom
You can see what I'm listening to, so to complete your multimedia profile, I'm reading Redcoats by Richard Holmes. If you're so inclined, you can pretend to be in my head.

I'm not sure I recommend it right now.

A Light Interlude

Befor the return to 'heavier', more depressing gibber, a little light relief, with help from our friends at YouTube.

More Stag related nonsense

Sex, Drugs and Getting Yer Ya-Ya's Out

The edited version. Part the first. The drugs.
One of Shroom's colleagues has been concerning him. X is increasingly prone to mood swings, and sometimes seems irrational. I have an idea that X is using opiates - maybe just codeine or tramadol - for their occasional euphoric effects, rather than their analgaesic efficacy. Morphine is very easy to come by in the ED. It would be a relatively small jump... or an huge one, depending on your perspective. Maybe I'm over-excited. I know my duty lies in confrontation if my fears are that strong, but I don't want to charge in. Maybe something else is going on. I shall talk to them. Simply voicing my fears here isn't good enough.
I'll let you know.

The Summer Had Inhaled, And Held It's Breath Too Long

There was supposed to be a part the second, and indeed a part the third yesterday, but technical difficulties intervened.

---Anyway; what had been on my mind was continuity of care. This has had the habit of picking up controversy from time to time. Like fluff on your favourite shirt, if you will. Mostly because some people think patients used to get it, and that they don't anymore. Either way, Emergency Medicine has never been about long term continuity of care; and this fact holds much of its appeal to some people. Such as your resident fungus. So it is in that context that I say I don't much care for it. I enjoy avoiding ward rounds and clinics as much as possible.

---However, it is occasionally nice to see what has happened to memorable patients that pass through the Department. Now, obviously, I care deeply about the fate of every living thing I encounter, but some I am happy to trust to my erudite colleagues in the rest of the hospital, and others I try to follow up myself. Either to see them and wish them well, or to see what the blue blazes was actually wrong with them (which can, of course, allow the occasional smug(implied) 'I told you so' to be floated)... as in:

Shroom: Ah, hello Mr Surgical Reg

Reg: Shroom; aren't you an A&E weasel? Why have you darkened the doors of my surgical shrine? I mean, ward?

Shroom: Just checking on Mrs Abdo Pain from yesterday. You know, the one you said had a UTI (urinary tract infection)

Reg: Turned out she had an aneurysm. We opened her last night.

Shroom: Aneurysm. My goodness. Gosh. Didn't someone suggest that yesterday... I could have sworn they did...

Reg: **grunt**

Shroom: No. That's right. It was ME! I said 'I think it's an aneurysm' and you said 'Fuck off, is it'; or something... well, fancy that. Funny how things go, eh?

I am perhaps a little less direct, but, I suspect, often just as annoying.

Sometimes, I think it's better not to know. The fella I saw last week who'd come off his bike, with two smashed knees has been waiting days for transfer. At the time his partner asked if he might lose a leg. Having seen injuries like these before I had to admit it was possible, but, rather foolishly tried to downplay the idea. Privately, I felt sure he had a high chance of ending up with at least one amputation at some point, and the longer he waits for definitive surgery, the more debridement that goes on, the more likely this seems.

After what seems like months of driving rain, and flooding throughout the country, I was delighted to hear today that my local water company up London has finally lifted the hosepipe ban. The irony is almost killing me.

---A couple of funny old cases today. The weather was again dominated by gales and driving winds - gusting around the 90 -100 mph mark they tell me. This is more than enough to knock over pensioners on giro day. However our first was a fella who fell off a roof, trying to rescue a cat. Despite looking as if he had sustained multiple injuries, I couldn't find a damn thing wrong with him. We admitted him anyway, in case there was something lurking (I particularly distrust the retroperitoneum. I would advise you all, especially those in the legal profession, to make this top of your list of Body Cavities You Don't Trust. It surely tops mine.)

The second was an older lady, who despite looking well enough from end of bed, I couldn't find a damn thing right with her. She is one I'll follow up on...

If Songs Were Lines In A Conversation, The Situation Would Be Fine

Part the first... events on a stag night.

Things you least expect to see, having staggered into the night on a cold Saturday Morn...
Naked Rickshaw Man!




I think he's getting some cash out.



The only sensible response?

Pure Tomfoolery!

So, you must have gathered there's not a great deal of medical drama in this post... It was one of The Shroom's good friend's stag do this weekend. The groom to be had initially been reluctant to engage in anything too elaborate. Of course we ignored him. Dinner and drinks on Friday night, followed by hangovers and shooting on Saturday morning. Most of us had to have a siesta after that, which is frankly shameful. The ravages of age and whatnot. Then, dinner and gambling down at the Dogtrack... I think everyone but the Shroom and the Best Man won at least once. The Shroom had the knack of picking the dog that came in second, but not the sense to bet on them to place.

The Bottle of Shattered Dreams

(---losing tickets to the rest of you)

Despite his reservations, I think the Boy had a good time; and he won the shooting... despite us having a bone-fide Army man among us. (But he would want me to remind you that he deals mostly in area effect munitions.

Having exhausted our minds and bodies on the fields and dancefloors of the city of dreaming spires, we returned to our Hotel, to find it in full swing. Some company was having a function there, and I have rarely seen so many drunk people liberally scattered about a building - not since Med School anyway.

A special mention must go to the naked man I saw roaming to corridors at 0330hrs pleading desperately for a condom - "for the love of God, someone must have a rubber?!?"

I really felt for him...